DCRM 2023

Technology might have a positive impact in assessment and training within cognitive rehabilitation. It might advance our insight in cognitive functions and skills of patients, help finetune psychoeducation, motivate patients during training and evaluate learned compensation strategies during dynamic, interactive gameplay.

This sounds wonderful, so… how come we don’t implement technology straight away?

During this mini symposium we will focus on several types of technology (digitized neuropsychological assessment, experimental cognitive tasks, Virtual and Augmented Reality) and expert opinions of both patients and therapists.

Chair and speakers: 

• PhD Tanja Nijboer, associate professor UMC Utrecht
• MD Elsemiek Stehouwer, resident rehabilitation medicine UMC Utrecht
• MSc Judy Bakker, ergotherapeut & PhD-student Utrecht University / Omring
• MSc Sanne Boing, PhD student Utrecht University
• MSc Eileen Bousche, PhD student Utrecht University
• PhD Hanne Huygelier, post doc research fellow UMC Utrecht, KU Leuven

Programme:

• Elsemiek will present (preliminary) results on patients’ perspective of the current conventional pen-and-paper neuropsychological assessment (cNPA). In a survey, we collected responses of patients on their experiences with the cNPA.
• Judy will present results of a large survey among professionals on their perspectives (and experiences) of a digitized NPA (dNPA). What are the (potential) advances, and (potential) pitfalls?
• Sanne will present her work on an experimental task to assess working memory in a more ecologically valid way. Currently working memory is assessed by having patients remember all the stimuli, whereas in real life we can still rely on our environment to a certain extent. Switching back and forth between remembering and relying on the outside world might be the best strategy to function in daily life.
• Eileen will focus on Virtual and Augmented Reality Serious Games in rehabilitation. What are the expert opinions on several different serious games designed for visual scan training for patients with visuospatial neglect?
• Last, Hanne will talk about her research with HemiRehApp, a Virtual Reality Serious Game. In her study, 43 stroke patients with visuospatial neglect completed a neglect assessment. Associations between cNPA and new outcome measures will be discussed as well as the user experience of the patients

To deliver sustainable value based rehabilitation care for all who need it, significant changes are needed to deliver the right care in the right setting at the right moment. To meet this,

multidisciplinary network care pathways are developed at Rijndam Rehabilitation through action research for outpatient rehabilitation and follow-up care after acquired brain injury (ABI) and spinal cord injury (SCI). These new care pathways are cocreated with patients and network partners, such as primary care physiotherapists. Further, they are based on the four elements of value based health care: patient value, costs, organization of care and continuous improvement. During the workshop we will work on two essential themes in the development of these care pathways: how to cocreate a care pathway with patients and network partners and how to incorporate outcome and experience measurement for shared decision making and healthcare evaluation.

Learning objectives

• To learn about cocreation with patients and network partners in the development of multidisciplinary network care pathways. We will explore the added value, barriers and lessons learned in working together in the development of the care pathway.
• To learn about the organisation and added value of outcome and experience measurement for shared decision making and health care evaluation in multidisciplinary network care. We will explore the challenges we faced and goals for further development.
• To learn about implementing value based health care principles in multidisciplinary network care.

Presenters: 

• PhD Rutger Osterthun, rehabilitation physician Rijndam Rehabilitation And Erasmus Medical Center
• PhD Erik Grauwmeijer, rehabilitation physicianRijndam Rehabilitation And Erasmus Medical Center
• MSc Mildred Visser, PhD student Erasmus School of Health Policy & Management, Erasmus University

Programme:

• Introduction (15 min): Short introduction on action research, elements of Value Based Health Care, and the development of multidisciplinary network care pathways for persons with acquired brain injury and spinal cord injury at Rijndam Rehabilitation (15 min)
• Cocreation with patients and network partners to develop multidisciplinary network care pathways (30 min): Interactive session in which the formation of and working with a multidisciplinary network team will be discussed. Central theme of the session is cocreation of healthcare with patients and network partners. The added value, barriers, facilitators and lessons learned will be addressed.
• Outcome and experience measurement in multidisciplinary network care pathways for shared decisions-making and healthcare evaluation (30 min): Interactive session in which routine outcome and experience measurement during rehabilitation care for shared decision making and healthcare evaluation is the central theme. The added value, barriers, facilitators and lessons learned will be discussed.
• Panel discussion (15 min): At least one patient and one primary care provider will be invited to join the panel discussion.

In English 

IMPT is highly relevant for patients with chronic pain with high levels of disability and participation problems. However, reported effect sizes are at best moderate and variable across multiple outcome measures. To improve IMTP’s effectiveness/efficacy, a personalized approach is advocated by involving the patient in shared decision making to assess whether an IMPT is warranted, and which personal outcomes are relevant. This mini-symposium discusses whether the used outcome measures in predictive modelling are clinimetrically sound, and relevant to individual patients. A synthesis of current evidence and weaknesses of identified predictive factors of successful IMPT is presented, followed by a critical appraisal of the generalizability to clinical practices. Next, the results of recently performed logistic regression modelling using factors identified from literature and a consensus meeting of researchers, clinicians, and patients is presented, followed by results from a IMPT machine learning study examining multiple prognostic outcome measures to establish a stratified patient profile. Data of 2300 patients treated with IMPT at CIR is used. Strength and weaknesses of both modelling techniques and the impact of practical modelling decisions is discussed. Finally, we discuss how these prognostic algorithms might assist with shared decision making, goal setting, and improved patient outcomes.

Learning objectives:

• Critical appraisal of predictive factors and outcomes of IMPT and the relevance of predictive models
• Improve the selection of potential prognostic factors to build predictive models using logistic regression technique
• Increase awareness of the strengths and weaknesses of logistic regression models
• Improve knowledge of the potential value of machine learning predictive algorithms across multiple IMPT outcome measures to develop a prognostic patient profile
• Increase knowledge of how to use prognostic models in shared decision making and whether to start an IMPT or not
• How to use prognostic models to improve personalised assessment and patients’ IMPT program engagement and goal setting

Speakers: 

• Prof. Rob Smeets, professor rehabilitation medicine Cir Clinics In Revalidatie and Maastricht University, research school CAPHRI and department of Rehabilitation Medicine
• Dr Michel Mertens, Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Belgium
• MSc Fredrick Zmudski, senior health economist and policy analyst Époque Consulting and University of New South Wales, Social Policy Research Institute Centre

Programme: 

The session starts with a brief introduction by the chair and some questions using Menti-meter (background audience, outcome measures, predictive models and machine learning; 10 minutes). Next three lectures of 20 min with 5 min of questions for clarification after each lecture, followed by a general discussion facilitated by chair using polls and voting using Menti-meter.

We also propose audio recording to later study the session and maybe use it to write an opinion-based paper and invite audience involvement.

• Introduction by Rob Smeets (Chair) and voting (10 minutes)
• Presentation by Rob Smeets: What outcome measures matter to patients, clinicians and other stakeholders to predict IMPT? And are these outcomes and their so far identified predictive factors relevant for shared decision-making?
• Presentation by Michel Mertens: Results of prognostic logistic models for successful IMPT provided by CIR clinics in rehabilitation while using potential predictive factors identified by literature, care-providers and patients. What are the strengths and weaknesses?
• Presentation by Fredrick Zmudzki:What can machine learning predictive algorithms contribute to Dutch IMPT provided at CIR rehabilitation clinics? And how can a prognostic patient profile help clinicians improve collaborative personalised IMPT assessment goal setting?

Medisch specialistische revalidatie gaat ver met een nieuw perspectief weer mee doen in je eigen omgeving. Om zicht te krijgen op dit perspectief en tegemoet te komen aan de behoefte van de unieke patiënten zijn toegankelijkheid, gelijkwaardigheid, diversiteit, en inclusie een randvoorwaarde. Vanuit het patiënt-perspectief kan de ervaringsdeskundige ons daarbij helpen.

Op 7 juni organiseerden VRA en RN met ervaringsdeskundigen en onderzoekers de studie- en intervisiebijeenkomst “Ervaringsdeskundigheid in de revalidatie: oriëntatie, inspiratie en motivatie?!” Deze bijeenkomst stond in het teken van de meerwaarde van ervaringsdeskundigheid in de medisch specialistische revalidatie en was bedoeld voor ervaringsdeskundigen, behandelaren, revalidatieartsen, bestuurders, managers en beleidsmakers in de revalidatie.

Deze workshop is stap 2: indien je als revalidatiearts overtuigd bent van de meerwaarde, hoe kun je dan de kennis en ervaring van (voormalige) patiënten het beste in het behandeltraject gebruiken, welke vormen bestaan er en waarmee krijg je dan te maken?

Leerdoelen: 

Na afloop van de sessie hebben deelnemers

• Kennis van de toegevoegde waarde van ervaringskennis voor de patiënt
• Kennis van de verschillende vormen van ervaringsdeskundigheid
• Kennis wat nodig is voor om goed je plek als ervaringsdeskundige te kunnen vinden
• Eerste idee wat nodig is voor implementatie in eigen regio

Speakers: 

• MD Annette Van Kuijk, revalidatiearts Tolbrug Revalidatie
• Ruth Wobma, ergotherapeut en projectleider Reade 
• Marleen Kampert, ervaringsdeskundige Tolbrug Revalidatie
• Harmen Hidding, peercounselor neurorevalidatie Sint Maartenskliniek
• Jeroen Smale, beleidsadviseur Revalidatie Nederland

Programme:

• Welkom en inleiding – Annette van Kuijk, Voorzitter.
• Ervaringsdeskundigheid vanuit wetenschappelijk perspectief – Ruth Wobma Ruth Wobma bespreekt aan hand van korte film van Vilans en haar eigen promotieonderzoek, wat ervaringsdeskundigheid toevoegt vanuit het perspectief van de revalidant en welke verschillende vormen van ervaringsdeskundigheid er zijn
• Ervaringsdeskundigheid vanuit het perspectief van de ervaringsdeskundige binnen de medisch specialistische revalidatie – Harmen Hidding en Marleen Kampert. Marleen Kampert (ervaringsdeskundige Tolbrug) en Harmen Hiddink (ervaringsdeskundige Sint-Maartenskliniek) gaan vanuit het perspectief van de ervaringsdeskundige in op wat nodig is om goed je plek als ervaringsdeskundige te kunnen vinden.
• Ervaringsdeskundigheid diversiteit en complexiteit bij implementatie – Ruth Wobma
• Werksessie uit elkaar in groepen (20 minuten)  In deze groepen wordt met elkaar nagedacht en ervaringen uitgewisseld aan de hand van de opdracht: Ervaringsdeskundigheid: Waarom zou ik dat doen in mijn centrum, met wie en hoe zou het er dan uit kunnen zien.
• Plenair uitwisselen uitkomsten groepen (25 minuten) -Ruth Wobma. Ophalen opbrengsten groep: tips en ideeën; uitdagingen die aangepakt moeten worden.
• Rode draad en afsluiting (5 minuten) – Annette van Kuijk. Perspectief hoe verder op proces vanuit VRA en RN

Have you ever wondered why global health is relevant to rehabilitation care? Or how global health concepts and systems thinking can be used to strengthen rehabilitation care in the Netherlands?

Global health is relevant to rehabilitation care in the Netherlands, because it provides a broader perspective on the social, economic and environmental determinants that can impact rehabilitation health outcomes. Systems thinking, in turn, helps us to embrace the inherent complexity of these factors. Many health issues are interconnected and cannot be addressed in isolation. The analysis of the interdependence of these determinants leads to new insights into how global health can be promoted and health disparities can be reduced (Faerron Guzman, 2018). Did you know that, in general, healthcare systems contribute only 20% to the overall health of a population?

In this mini-symposium, we will focus on topics such as health equity, equality and social justice and how these topics impact your daily rehabilitation practice. For example, did you know that people who fall into low income groups enjoy 15 years less in good health? Or, do you think that children with disabilities have the same opportunities to participate in the Netherlands? Divided into expert groups, we will discuss and tackle four topical issues in rehabilitation medicine in the Netherlands, and attempt to come up with possible solutions, using concepts related to both systems thinking and global health.

Learning Objectives: 

• Awareness of the social determinants of health
• Awareness of health equity and equality and social justice
• Understand the value of health equity and equality and how it can be used as a fundamental basis for rehabilitation care in the Netherlands

Speakers: 

• MD Alicia Lucardie, rehabilitation physician Adelante, VRA Werkgroep Transculturele Revalidatie (WTcR)
• Prof. dr. Jan Willem Gorter, professor pediatric rehabilition medicine, UMC Utrecht
• Jos Metselaar, Broadview Changing Perspectives
• PT Karin Schepman, 5FHHRO | Medical Human Rights Network, VRA Werkgroep Transculturele Revalidatie (WTcR)
• MD Marga Tepper, rehabilitation physician UMCG, VRA Werkgroep Transculturele Revalidatie (WTcR)

Programme:

• Welcome and Introduction (5 min) – Jan Willem Gorter, chair
• From Global Health to Rehabilitation Medicine for all in the Netherlands: Thorny truths (20 min) – Alicia Lucardie
• Systems Thinking – Why does it matter? (20 min) – Jos Metselaar
• Expert discussions in four groups – Rehabilitation medicine for all: reality or fiction in Dutch daily practice? (40 min) – Jan Willem Gorter, Alicia Lucardie, Jos Metselaar, Karin Schepman, Marga Tepper
• Closing Remarks (5 min) – Jan Willem Gorter

Dance is an art form. More and more is known about dance as medicine. And how to use dance for health. It fits perfectly in the theme ‘Rehabilitation for all: equality and inclusivity’ . “Dans op Recept” has won the &award in 2020 of “Code diversiteit & inclusie” (https://codedi.nl/inspiratie-tips/winnaars-awards-2020-bekendgemaakt)

In this mini-symposium we will introduce this topic and talk about how dance can be used in daily practice for different patient categories (NAH, Parkinson, chronic pain, MS, dementia).

Learning objects:

After this mini-symposium the participants are aware of the evidence for dance as medicine and have information how it can be used in a rehabilitation program, and maybe be inspired to implement it themselves. They can also inform and advise patients to join dance classes or join projects outside the rehabilitation center where dance is used as medicine. They will also have experienced themselves in an interactive dance session what the added value of dance can be.

Speakers: 

• MD Anandi Van Loon-felter, rehablitation physician 1Lucia Marthas Insititute For Performing Arts / Hand en Pols Revalidatie Nederland
• Drs Wya Feenstra, rehabiliation physician Revalidatie Friesland
• Marlies Seinstra, Generatiehuis en Dans op Recept
• Yentl Smeets, dance teacher Lucia Marthas Institute for Performing Arts

Programme:

• General introduction to topic ( 5 min) – Anandi van Loon-Felter
• Evidence of dance in acquired brain injury / results of current research with Revalidatie Friesland (25 min) – Wya Feenstra
• “Dans op Recept” (25 min) – https://dansoprecept.nl/ – Marlies Seinstra. She will talk about “dans op recept”,  give insights about vision projects like “dans op recept”, inclusion dance in general 
• Dance performance  (10 min). Solo created by a participant of chronic pain dance group.
• Yentl Smeets Honours student – Dance teacher LMIPA will talk about his role in the project for Zang- Toneel- en Dansacademie Daan Theeuwes i.s.m. Lucia Marthas. He will give an interactive session and let the participant experience how dance can be done by everybody (25 min)

Survivors of Intensive Care (ICU) can experience problems in daily functioning for years. The problems directly attributable to ICU admission have been described since 2012 with the umbrella term ‘Post Intensive Care Syndrome’ (PICS). PICS has been defined as new or worsening problems in the physical, mental and/or cognitive domain, which arise after experiencing a critical illness and which persist after a stay in an ICU (Needham, 2012). Family members of ICU patients can also experience mental complaints: PICS varies widely from 25 to 80% depending on the population studied.

In 2022, the FMS guideline After Care and Rehabilitation of Intensive Care Patients was published under the chairmanship of the VRA and Nederlandse Vereniging voor Intensive Care (NVIC). This guideline provides recommendations on interventions to prevent, decrease and treat symptoms of PICS and PICS-Family during and after ICU stay.

In order to optimize the functional recovery of patients with PICS, the objective of this workshop is to present -in brief- the content of the guideline After Care and Rehabilitation of Intensive Care Patients, to provide participants with practical tools for implementing the recommendations in their daily practice and to make a first move towards a ‘treatment framework’ (Dutch: behandelkader) for Rehabilitation of PICS.

Learning objectives:

At the end of this workshop, participants:

• Have insight in the guideline recommendations related to rehabilitation
• Are provided with a tool to implement the guideline in their own setting.
• Have discussed common implementation issues for the rehabilitation of PICS such as rehabilitation goals, and the responsibility and expertise of team members.

Speakers: 

• PhD Marike Van Der Schaaf, associate professor Amsterdam Umc, department of Rehabilitation medicine, Amsterdam University of Applied Sciences
• MD, PhD Chantal Bakker, rehabilitation physician Máxima Medisch Centrum
• PA Germijn Heijnen, Physician Assistant UMCU, department of Rehabilitation, Physiotherapy Science & Sport
• Intensivist (name will be announced soon).

Outline of the session:

• Welcome and introduction of the workshop, the implications of PICS for daily functioning, and the guideline After Care and Rehabilitation of Intensive Care Patients. (30 min).
• Group discussions: participants will be divided into groups to discuss current rehabilitation practice in relation to the guideline recommendations. A format will be provided to structure the session for discussing common implementation issues. Within these discussions, essential components of rehabilitation care, the multidisciplinary team, treatment activities and responsibilities will be discussed (30 min)
• Plenary presentation of results of the group discussions. Pitches of the main results by each group according to the provided format. The results serve as a starting point for the implementation of the guideline in participants’ own setting, as well for the development of a treatment framework (behandelkader) PICS that will be developed by the VRA Working group IC Rehabilitation (WICR) (20 min).
• Wrap up and conclusions: How do we turn this guideline into reality? (10 min)

Dit mini symposium richt zich op de functionele behandeling van spasticiteit in de onderste extremiteit met behulp van selectieve neurectomie, een behandelingsmethode die nog weinig wordt toegepast in Nederland. In deze sessie gaan we in op de indicatiestelling met selectieve zenuwblokkade en de chirurgische techniek van de selectieve neurectomie, zoals die in het Radboudumc in Nijmegen wordt uitgevoerd. Vervolgens zullen we de resultaten bespreken van een systematische review van de literatuur. Tenslotte presenteren we de eerste resultaten van een studie naar de effecten van selectieve neurectomie op zelfgekozen loopdoelen en de eerste patiëntervaringen.

 Leerdoelen:

• Inzicht in de indicatiestelling van selectieve neurectomie voor de functionele behandeling van spasticiteit in de onderste extremiteit.
• Inzicht in de chirurgische techniek van selectieve neurectomie
• Inzicht in huidige stand van de wetenschap van selectieve neurectomie van de onderste extremiteit
• Kennis van eerste resultaten en ervaringen van patiënten na selectieve neurectomie ter verbetering van loopproblemen.

Sprekers: 

• PhD Hanneke Van Duijnhoven, revalidatiearts Radboudumc
• MD Erkan Kurt, neurochirurg Radboudumc
• MD Danique Ploegmakers, revaildatiearts Radboudumc en Sint Maartenskliniek
• MSc Jean Ormiston, junior researcher Sint Maartenskliniek
• MD PhD Tim de Jong, plastisch chirurg Radboudumc
• PhD Jorik Nonnekes, revalidatiearts Radboudumc en Sint Maartenskliniek

Programma:

• Indicatiestelling middels functionele diagnostiek en selectieve zenuwblokkade (15 minuten) – Hanneke van Duijnhoven:
• Chirurgische techniek van selectieve neurectomie van de onderste extremiteit (15 minuten) – Erkan Kurt
• Systemische review van de literatuur over selectieve neurectomie voor de behandeling van spasticiteit in de onderste extremiteit (15 minuten) – Danique Ploegmakers
• Effectiviteit van selectieve neurectomie op zelfgekozen loopdoelen: de eerste resultaten en ervaringen van patiënten. (30 minuten) – Jean Ormiston
• Discussie en gelegenheid voor het stellen van vragen (15 minuten)